Case report Korean J Pediatr 2013;56(9):411-415 http://dx.doi.org/10.3345/kjp.2013.56.9.411 eISSN 1738-1061•pISSN 2092-7258

Korean J Pediatr

Mycoplasma pneumoniae associated stroke in a 3-year-old girl Gun-Ha Kim, MD1, Won Hee Seo, MD, PhD1, Bo-Kyung Je, MD, PhD2, So-Hee Eun, MD, PhD1 Departments of 1Pediatrics and 2Radiology, Korea University College of Medicine, Seoul, Korea

Infectious diseases precede a significant proportion of acute ischemic strokes in children. Here, we report a case of acute ischemic stroke in a 3-year-old girl with a Mycoplasma pneumonia -associated respiratory tract infection. She developed an acquired prothrombotic state of protein S deficiency and had increased fibrinogen and fibrinogen degradation product levels and increased titer of antinuclear antibodies. However, these conditions were completely alleviated at the 1-month followup examination. Infection with M. pneumoniae may cause a transient prothrombotic state that can potentially cause a thrombus.

Corresponding author: So-Hee Eun, MD, PhD Department of Pediatrics, Korea University Ansan Hospital, Korea University College of Medicine, 123 Jeokgeum-ro, Danwon-gu, Ansan 425-707, Korea Tel: +82-31-412-5096 Fax: +82-31-405-8591 E-mail: [email protected]

Key words: Mycoplasma pneumoniae, Stroke, Child

Received: 14 September, 2012 Revised: 10 December, 2012 Accepted: 15 January, 2013

Introduction Childhood stroke, by definition, is a cerebrovascular event that happens between 30 days and 18 years of age. Stroke in children is rare, with an annual incidence of 2–4/100,000 in the United States1), but ischemic stroke is more common than hemorrhagic stroke. Furthermore, infectious diseases precede a significant proportion of acute ischemic strokes (AIS) in children. Based on the research done by the International Pediatric Stroke Study (IPSS), at least 24% of cases of AIS were related to infection2). The most common infectious agent is Varicella zoster virus, but other causes including Mycoplasma pneumoniae, Chlamydia pneumoniae , Parvovirus B19, Borrelia burgdorferi , influenza A virus, Human immunodeficiency virus, and mumps virus infection have been identified as potential risk factors for arterial ischemic stroke during childhood. However, only 11 cases of M. pneumoniae -associated AIS in childhood have been reported. In addition, four of the 11 cases were presumed to be related to a prothrombotic state, but none of them was proved to be acquired. Here, we report a case of acute stroke in a 3-year-old girl who presented on the seventh day of M. pneumoniae infection with an acquired prothrombotic state, which was normalized 1 month later.

Case report

Copyright © 2013 by The Korean Pediatric Society

A previously healthy 3-year-old girl with left-sided paresis was admitted to the Department of Pediatric Neurology in Korea University Ansan Hospital. Seven days before admission, she experienced an abrupt onset of high fever and cough. Three days prior to admission, fever subsided, but she was diagnosed with pneumonia at a local clinic. On the day of admission, left-sided hemiparesis and left facial palsy developed. She

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http://dx.doi.org/10.3345/kjp.2013.56.9.411

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Kim GH, et al. • Childhood stroke and Mycoplasma pneumoniae

was transferred to our hospital with the presumed diagnosis of encephalitis from the local clinic. The patient’s family history and past medical history were unremarkable. Physical examination on admission revealed an alert, oriented girl. Her body temperature was 36.2˚C, pulse rate 104/min, respiratory rate 22/min, and blood pressure 105/56 mmHg. Chest examination revealed crackles on the right lung. On neurological examinations, central type facial palsy was observed on the left side of face, and motor strength was decreased to grade III/VI in the left arm and leg. Initial laboratory studies showed a white blood cell (WBC) count of 15,110/mm3 with neutrophils of 60.9%, lymphocytes of 27.6%; hemoglobin, 13.0 g/dL; and platelets, 449,000/mm3. The erythrocyte sedimentation rate was 63 mm/hr and C-reactive protein, 0.5 mg/dL (reference range,

Mycoplasma pneumoniae associated stroke in a 3-year-old girl.

Infectious diseases precede a significant proportion of acute ischemic strokes in children. Here, we report a case of acute ischemic stroke in a 3-yea...
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